By Becca Boesl

DNP, FNP, AG-ACNP

Lake Region Healthcare Internal Medicine

You have probably seen a commercial, come across advertisement online, or maybe even have a friend or coworker who is on a medication for weight loss. Perhaps, you have even wondered if a weight loss medication might be a good option for you. Across the country demand for weight loss drugs continue to increase, and no doubt we are seeing this locally as well. As a primary care provider, I thought it might be helpful to review some of these medications with you, along with their implications for use. 

What should I consider before starting a medication?

Weight loss medications are prescription medications intended to be used in addition to (not instead of) a healthy diet and regular exercise. You should not try a medication for weight loss if you are not consistent with a healthy diet and regular exercise, as outlined below.  

What is meant by a healthy diet: Briefly, daily caloric intake to maintain weight is about 2000 calories per day for women, and 2500 calories per day for men. Remember, if you are trying to lose weight, you should be in a calorie deficit. A calorie deficit means you are burning more calories than you are eating. Calorie intake should be reduced by 500 calories per day to try to achieve one pound weight loss per week. A healthy diet includes 5 servings of fruits and vegetables per day (corn, potatoes, and sweet potatoes do not count), and at a minimum, 0.8grams for protein per kilogram of body weight. If you are exercising regularly this may increase to 1.2-1.7 grams per kg to help build muscle mass. A healthy diet is also low in sugar, salt, and trans/saturated fats. Total dietary fiber intake should be around 25-30 grams per day. Fluid intake should include at least 8 cups of water per day and alcohol should be limited to no more than 1 drink per day for women or 2 drinks per day for men. 

I usually suggest my patients keep a food journal for a couple of weeks to help create mindfulness about what you are putting in your body and where calories are coming from. A referral to a dietician and/or our lifestyle medicine program is also often recommended. 

What is meant by regular exercise: Evidence shows us that regular exercise is one of the most important things you can do for your health. Being physically active can improve your brain health, help manage weight, reduce the risk of disease, strengthen bones and muscles, and improve your ability to do everyday activities. Regular exercise means incorporating at least 150 minutes of moderate aerobic activity per week. This includes brisk walking, swimming, or really any activity that helps elevate the heart rate for a sustained period of time. In general, try to aim for 20-30 minutes of physical activity per day. Two days per week add some strength training exercises for all major muscle groups. 

I also like to talk to my patients about the importance of sleep. Adequate sleep is so important for overall health and to help achieve and maintain weight loss. Try to get 7-8 hours of sleep per night.   

Who is considered a candidate for weight loss medication? 

If you are largely consistent with the above diet and exercise recommendations and are still having trouble achieving weight loss, a prescription medication might be an option for you if your body mass index (BMI) is greater than 30. Your BMI is calculated based on height and weight. A healthy BMI is considered between 18.5 and 24.9. A weight loss medication may also be considered if your BMI is greater than 27 and you have other medical problems associated with obesity such as heart disease or diabetes. 

What medications are available and what else should I know about them?

There are six medications currently approved by the United States Food and Drug Administration (FDA):

• Contrave (bupropion-naltrexone)- twice daily oral medication

• Qsymia (phentermine-topiramate)-once daily oral medication

• Saxenda (Liraglutide)-once daily injection 

• Xenical or Alli (Orlistat)- three times daily (with meals) oral medication

• Wegovy (Semaglutide)- once weekly injection 

• Imcivree (Setmelanotide)-once daily injection 

Through various methods, most of these medications work by decreasing appetite and making you feel full longer. 

Other considerations:

• Though these medications have been proven to help achieve weight loss, some patients do experience side effects. Side effects vary depending on the medication, but in general nausea, constipation and diarrhea can occur. Rarely, serious side affects can occur. It is important to talk to your healthcare provider and pharmacist about side affects prior to starting a medication. 

• These medications can be expensive and are sometimes not covered well by insurance. It may be helpful to talk to your insurance company about coverage for FDA approved weight loss medications prior to your appointment. Unfortunately, your healthcare provider cannot control insurance coverage. You also have the option to pay for the medication out of pocket. 

• Many people gain back some of the weight they lost once they stop taking the medication. Often the medication is recommended long term if successful and tolerated well. A 2021 study published in the Journal of the American Medical Association showed that patients who stopped taking Wegovy gained back 2/3 of the weight they had lost once they stopped taking the medication. 

• Supply/availability of the medication from pharmacists may be limited. We are currently seeing this especially with Wegovy.   

• Initially, you should plan on follow up with your healthcare provider every 6 weeks to monitor progress and check heart rate and blood pressure. It may also be recommended to have monthly pregnancy tests in women of child bearing ages, depending on what medication you are taking. 

The bottom line

There is not one simple solution out there for weight loss and there is NO alternative to a healthy diet and exercise. Let’s say that again, there is NO alternative to a healthy diet and exercise! I tell my patients, I care less what the number on the scale says. I want to hear that you are eating well, that you are exercising, and that you are taking care of your body. Our bodies go through so much in a lifespan. Injuries, illness, childbearing, menopause, effects of aging, not to mention the impact our mental health can have on our physical health over time. Give yourself grace, and work on small, sustainable changes over time.  

If you struggle with your weight or how you feel about your body, talk to your healthcare provider. Make an appointment. We are here for you. We want to help you. We can also connect you to helpful resources like medical nutrition referrals or Lifestyle Medicine solutions with our personal trainers, nutrition coaches, and health coaches at our Unity Wellness Center. And remember, we care about your health, not just your weight.